Abstract

Background: Postextubation respiratory failure is associated with increased mortality. The role of high-flow nasal cannula (HFNC) oxygen therapy in high-risk patients has not been clarified in postextubation failure. This study aimed to determine whether HFNC reduces postextubation respiratory failure in high-risk patients compared with conventional oxygen therapy.

Methods: A single-center randomized controlled trial was conducted in Taiwan's 25-bed adult medical intensive care units (ICUs) from September 2014 to September 2016. Enrolled patients with high-risk postextubation failure were randomized to receive either HFNC or conventional oxygen therapy for 72 hours postextubation. Primary outcomes were rate and causes of postextubation respiratory failure within 72 hours. Secondary outcomes included the ICU length of stay, 28-day mortality, and 48-hour postextubation physiologic values.

Results: Of 56 patients, 29 received HFNC and 27 received conventional oxygenation therapy. Fewer patients developed respiratory failure in the HFNC (0/29, 0%) than in the Conventional Group (7/27, 25.9%) (odds ratio 0.408 [95% confidence interval, 0.29–0.57], p = 0.0038). There was no significant difference in the ICU length of stay, 28-day postextubation mortality, multiorgan failure, or the 48- hour postextubation physiologic variables. However, there was a trend toward better oxygenation in the HFNC Group (102.4 ± 25.4 vs. 86.6 ± 26.4 mmHg, p = 0.148).

Conclusion: Among patients at high risk for extubation failure, HFNC reduced the risk of postextubation respiratory failure compared to conventional oxygen therapy.